Seppo Koskinen

Mortality in a large population-based cohort of patients with drug-treated diabetes mellitus

OBJECTIVESnThis paper presents detailed cause-specific data about excess mortality among diabetic persons in Finland, by age and sex.nnnMETHODSnFive-year follow-up data on the Finnish population aged 30 through 74 years were analyzed. During these 5 years, 11,215 persons with diabetes and 102,843 persons without diabetes died. The diabetic population was defined as people who were entitled to free medication for diabetes at the beginning of the follow-up period, that is, at the end of 1980.nnnRESULTSnThe relative mortality of persons with drug-treated diabetes compared with nondiabetic persons was higher among women (3.4) than among men (2.4). Almost three quarters of the mortality excess was due to circulatory diseases. For most other causes of death, too, diabetic persons had higher than average mortality. The exceptions were lung cancer, chronic obstructive pulmonary disease, and alcohol poisoning.nnnCONCLUSIONSnDiabetes is a general risk factor for untimely death and makes a significant contribution to overall national death rates, particularly for circulatory diseases. Lower than average mortality from smoking-related diseases and alcohol poisoning, however, warrant optimism about the effects of health education among diabetic persons.

Socioeconomic differences in mortality among diabetic people in Finland: five year follow up

Abstract Objective: To compare socioeconomic differences in mortality (by cause of death) among diabetic people with those in the rest of the population. Design: Five year follow up of mortality in the population of Finland, comparing people with diabetes and those without diabetes. Setting: Finland. Subjects: All residents of Finland aged 30 to 74 included in the 1980 census. Subjects were classified as diabetic (230 000 person years) or other (12 400 000 person years) according to whether they were exempted from charges for medication for diabetes. During 1981–5 there were 114 058 deaths, of which 11 215 were in people with diabetes. Main outcome measures: Age standardised mortality by sex, social class, and cause of death for the diabetic and non-diabetic populations. Results: No significant social class differences in mortality were found among women with diabetes. Among diabetic men there was a slight increasing trend in mortality from the upper white collar group to the unskilled blue collar workers but it was much less steep than that of non-diabetic men. Conclusions: Among people with diabetes in Finland the quality of treatment and compliance with treatment probably do not vary by socioeconomic status. Health education for diabetic people seems to be effective in all socioeconomic strata; in people from the lower strata this leads to greater changes because their health behaviour was originally less good. Key messages In diabetic men a slight increasing trend in mortality was found from the upper white collar group to the unskilled blue collar workers, but it was much less steep than that in non-diabetic men These results may show that among diabetic people in Finland health education is effective in all socioeconomic strata, leading to greater changes in the lower strata due to their poor original health behaviour Equitable health services may alleviate health inequities in a subpopulation where the impact of health services is particularly important

Coronary heart disease among diabetic and nondiabetic people — socioeconomic differences in incidence, prognosis and mortality

OBJECTIVEnTo investigate coronary heart disease (CHD) morbidity and mortality and their patterning by socioeconomic status among diabetic and nondiabetic individuals in Finland.nnnMETHODSnAll diabetic persons aged 35-74 years entitled to free anti-diabetic medication were drawn from the 1991-1996 national health insurance files along with nondiabetic referents. Outcome events for up to 6 years of follow-up, corresponding to 418,987 and 867,813 person-years in diabetic and nondiabetic people, respectively, were identified from national health insurance, hospital discharge and causes of death registers using personal identification codes.nnnRESULTSnThe annual CHD incidence for diabetic women and men was 2.7% and 3.7%, respectively, corresponding to relative risks of 3.55 (95% CI: 3.43-3.67) and 2.64 (95% CI: 2.56-2.72) compared to nondiabetic persons. The impact of diabetes on CHD mortality was greater, with relative death rates of 6.04 and 3.42 for women and men, respectively. CHD mortality and incidence displayed systematic socioeconomic trends with higher rates among worse-off diabetic and nondiabetic people, although gradients were generally steeper for nondiabetics. In the diabetic population, socioeconomic differences were rather similar for sudden CHD deaths and nonfatal CHD incident cases. For both genders, socioeconomic differences in mortality after CHD diagnosis were small in both diabetic and nondiabetic persons, except for the lowest compared to the highest income quintile.nnnCONCLUSIONSnSocioeconomic CHD mortality differences among diabetic people in Finland were mainly explained by higher CHD incidence and particularly sudden deaths without prior CHD diagnosis. No systematic socioeconomic differences were found in long-term prognosis after CHD diagnosis.

Functional disabilities do not prevent the elderly in Finland from eating regular meals

The aim of this study was to depict the prevalence of different meal patterns of the elderly in Finland and to analyse the role of socio-demographic factors, functional capacity and help received as the determinants of following a conventional meal pattern. A nationally representative sample of elderly people aged 65 years and over and living at home (n=1697) in 2000-2001 was obtained. A structured (personal) interview was used for data collection. Regular hot meals are common among the elderly. Functional disability affecting the carrying out of food-related activities does not have an independent effect on the regularity of meals. The conventional meal pattern, which consists of breakfast, a hot lunch and a hot dinner, is more seldom followed by the elderly who have a low socio-economic status than by those whose educational level and monthly income are higher. The help received in carrying out food-related activities contributes to the ability to maintain a conventional meal pattern. In order to allow elderly people to live independently at home for as long as possible, special attention should be paid to the problems regarding meals in the lower socio-economic groups.

Commentary: problems in Finnish or British data--or a true difference?

Chaturvedi et al report a clear class gradient in mortality among diabetic people. In two separate data sets the death rate in the lowest socioeconomic group was roughly twice that in the highest group. In our recent study, covering the total Finnish population, we only found a non-significant 7% excess mortality among diabetic women in the lowest class compared with the highest class.1 Among diabetic men the corresponding excess was significant but still small (25%). The discrepancy between our results and those of Chaturvedi et al may reflect deficiencies in the Finnish or British data sets, or both, or reveal a true difference between the countries.nnBecause of our large data set, including 11 215 deaths among diabetic people, random variation could have had only a minor effect on our findings. The validity of the results can, however, be questioned. As the mortality follow up was complete, we are left with the possibility that the method of …